Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections
<b>Background:</b> Diabetic foot ulcers (DFUs) represent severe complications in diabetic patients, often leading to chronic infections and potentially resulting in nontraumatic lower-limb amputations. The increasing incidence of multidrug-resistant (MDR) bacteria in DFUs complicates tre...
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MDPI AG
2025-01-01
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| author | Mohd Saleem Soha Abdallah Moursi Tahani Nasser Almofeed Altamimi Mohammed Salem Alharbi Alwaleed Mohammad Alaskar Sahar Adly Hassan Hammam Ehab Rakha Ozair Ilyas Syed Muhammad Hamoud Abdulmohsin Almalaq Metab Nasser Alshammari Azharuddin Sajid Syed Khaja |
| author_facet | Mohd Saleem Soha Abdallah Moursi Tahani Nasser Almofeed Altamimi Mohammed Salem Alharbi Alwaleed Mohammad Alaskar Sahar Adly Hassan Hammam Ehab Rakha Ozair Ilyas Syed Muhammad Hamoud Abdulmohsin Almalaq Metab Nasser Alshammari Azharuddin Sajid Syed Khaja |
| author_sort | Mohd Saleem |
| collection | DOAJ |
| description | <b>Background:</b> Diabetic foot ulcers (DFUs) represent severe complications in diabetic patients, often leading to chronic infections and potentially resulting in nontraumatic lower-limb amputations. The increasing incidence of multidrug-resistant (MDR) bacteria in DFUs complicates treatment strategies and worsens patient prognosis. Among these pathogens, carbapenemase-producing pathogens have emerged as particularly concerning owing to their resistance to β-lactam antibiotics, including carbapenems. <b>Methods:</b> This study evaluated the prevalence of MDR bacteria, specifically carbapenemase-producing pathogens, in DFU infections. A total of 200 clinical isolates from DFU patients were analyzed via phenotypic assays, including the modified Hodge test (MHT) and the Carba NP test, alongside molecular techniques to detect carbapenemase-encoding genes (<i>blaKPC</i>, <i>blaNDM</i>, <i>blaVIM</i>, <i>blaIMP</i>, and <i>blaOXA-48</i>). <b>Results:</b> Among the isolates, 51.7% were confirmed to be carbapenemase producers. The key identified pathogens included <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i>, <i>Acinetobacter baumannii</i>, and <i>Escherichia coli</i>. The most commonly detected carbapenemase genes were <i>blaKPC</i> (27.6%) and <i>blaNDM</i> (24.1%). Carbapenemase-producing isolates presented high resistance to β-lactam antibiotics, whereas non-carbapenemase-producing isolates presented resistance through mechanisms such as porin loss and efflux pumps. <b>Conclusions:</b> The findings of this study highlight the significant burden of MDR infections, particularly carbapenemase-producing organisms, in DFUs. MDR infections were strongly associated with critical clinical parameters, including pyrexia (<i>p</i> = 0.017), recent antibiotic use (<i>p</i> = 0.003), and the severity of infections. Notably, the need for minor amputations was much higher in MDR cases (<i>p</i> < 0.001), as was the need for major amputations (<i>p</i> < 0.001). MDR infections were also strongly associated with polymicrobial infections (<i>p</i> < 0.001). Furthermore, Wagner ulcer grade ≥II was more common in MDR cases (<i>p</i> = 0.002). These results emphasize the urgent need for enhanced microbiological surveillance and the development of tailored antimicrobial strategies to combat MDR pathogens effectively. Given the high prevalence of carbapenem resistance, there is an immediate need to explore novel therapeutic options to improve clinical outcomes for diabetic patients with DFUs. |
| format | Article |
| id | doaj-art-bb128dbc41624d19a7b0878b73a9cca8 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-bb128dbc41624d19a7b0878b73a9cca82025-01-24T13:28:52ZengMDPI AGDiagnostics2075-44182025-01-0115214110.3390/diagnostics15020141Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer InfectionsMohd Saleem0Soha Abdallah Moursi1Tahani Nasser Almofeed Altamimi2Mohammed Salem Alharbi3Alwaleed Mohammad Alaskar4Sahar Adly Hassan Hammam5Ehab Rakha6Ozair Ilyas Syed Muhammad7Hamoud Abdulmohsin Almalaq8Metab Nasser Alshammari9Azharuddin Sajid Syed Khaja10Department of Pathology, College of Medicine, University of Hail, Hail 55476, Saudi ArabiaDepartment of Pathology, College of Medicine, University of Hail, Hail 55476, Saudi ArabiaDepartment of Family and Community Medicine, College of Medicine, University of Hail, Hail 55476, Saudi ArabiaDepartment of Internal Medicine, College of Medicine, University of Hail, Hail 55476, Saudi ArabiaDepartment of Diabetes and Endocrinology, King Salman Specialist Hospital, Hail 55471, Saudi ArabiaDepartment of Microbiology, Maternity and Children Hospital, Hail 55471, Saudi ArabiaLaboratory Department, King Khalid Hospital, Hail 55421, Saudi ArabiaDepartment of Surgery, King Khalid Hospital, Hail 55421, Saudi ArabiaDepartment of Medical Supplies, Hail Health Cluster, Hail 55471, Saudi ArabiaDepartment of Infection Control, King Khalid Hospital, Hail 55421, Saudi ArabiaDepartment of Pathology, College of Medicine, University of Hail, Hail 55476, Saudi Arabia<b>Background:</b> Diabetic foot ulcers (DFUs) represent severe complications in diabetic patients, often leading to chronic infections and potentially resulting in nontraumatic lower-limb amputations. The increasing incidence of multidrug-resistant (MDR) bacteria in DFUs complicates treatment strategies and worsens patient prognosis. Among these pathogens, carbapenemase-producing pathogens have emerged as particularly concerning owing to their resistance to β-lactam antibiotics, including carbapenems. <b>Methods:</b> This study evaluated the prevalence of MDR bacteria, specifically carbapenemase-producing pathogens, in DFU infections. A total of 200 clinical isolates from DFU patients were analyzed via phenotypic assays, including the modified Hodge test (MHT) and the Carba NP test, alongside molecular techniques to detect carbapenemase-encoding genes (<i>blaKPC</i>, <i>blaNDM</i>, <i>blaVIM</i>, <i>blaIMP</i>, and <i>blaOXA-48</i>). <b>Results:</b> Among the isolates, 51.7% were confirmed to be carbapenemase producers. The key identified pathogens included <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i>, <i>Acinetobacter baumannii</i>, and <i>Escherichia coli</i>. The most commonly detected carbapenemase genes were <i>blaKPC</i> (27.6%) and <i>blaNDM</i> (24.1%). Carbapenemase-producing isolates presented high resistance to β-lactam antibiotics, whereas non-carbapenemase-producing isolates presented resistance through mechanisms such as porin loss and efflux pumps. <b>Conclusions:</b> The findings of this study highlight the significant burden of MDR infections, particularly carbapenemase-producing organisms, in DFUs. MDR infections were strongly associated with critical clinical parameters, including pyrexia (<i>p</i> = 0.017), recent antibiotic use (<i>p</i> = 0.003), and the severity of infections. Notably, the need for minor amputations was much higher in MDR cases (<i>p</i> < 0.001), as was the need for major amputations (<i>p</i> < 0.001). MDR infections were also strongly associated with polymicrobial infections (<i>p</i> < 0.001). Furthermore, Wagner ulcer grade ≥II was more common in MDR cases (<i>p</i> = 0.002). These results emphasize the urgent need for enhanced microbiological surveillance and the development of tailored antimicrobial strategies to combat MDR pathogens effectively. Given the high prevalence of carbapenem resistance, there is an immediate need to explore novel therapeutic options to improve clinical outcomes for diabetic patients with DFUs.https://www.mdpi.com/2075-4418/15/2/141antimicrobial resistance (AMR)carbapenemase-producing organismsdiabetic foot ulcersmultidrug-resistant bacteria<i>Klebsiella pneumoniae</i> carbapenemase |
| spellingShingle | Mohd Saleem Soha Abdallah Moursi Tahani Nasser Almofeed Altamimi Mohammed Salem Alharbi Alwaleed Mohammad Alaskar Sahar Adly Hassan Hammam Ehab Rakha Ozair Ilyas Syed Muhammad Hamoud Abdulmohsin Almalaq Metab Nasser Alshammari Azharuddin Sajid Syed Khaja Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections Diagnostics antimicrobial resistance (AMR) carbapenemase-producing organisms diabetic foot ulcers multidrug-resistant bacteria <i>Klebsiella pneumoniae</i> carbapenemase |
| title | Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections |
| title_full | Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections |
| title_fullStr | Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections |
| title_full_unstemmed | Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections |
| title_short | Prevalence and Molecular Characterization of Carbapenemase-Producing Multidrug-Resistant Bacteria in Diabetic Foot Ulcer Infections |
| title_sort | prevalence and molecular characterization of carbapenemase producing multidrug resistant bacteria in diabetic foot ulcer infections |
| topic | antimicrobial resistance (AMR) carbapenemase-producing organisms diabetic foot ulcers multidrug-resistant bacteria <i>Klebsiella pneumoniae</i> carbapenemase |
| url | https://www.mdpi.com/2075-4418/15/2/141 |
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